Tivanka Sanjea Desilva, PHARMD
Individual provider Active NPI Pharmacist · Calera, AL
NPI 1083982870 · NPPES record last updated Dec 7, 2011
Key facts
- NPI
- 1083982870
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 16306 (AL)
- Practice address
- 1052 Pine Valley Dr
Calera, AL 35040-4710 - Phone
- (205) 744-9972
- NPI assigned
- Dec 7, 2011
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16306 | AL | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 16306 | AL | Yes |
Addresses
Primary practice location
1052 Pine Valley Dr
Calera, AL 35040-4710
Mailing address
1052 Pine Valley Dr
Calera, AL 35040-4710
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100003308 | Medicaid | AL |
Other providers in Calera, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 7, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.